RT Journal Article SR Electronic T1 Impact of cognitive impairment on clinical outcomes in elderly patients with atrial fibrillation: ANAFIE Registry JF BMJ Neurology Open JO BMJ Neurol Open FD BMJ Publishing Group Ltd SP e000370 DO 10.1136/bmjno-2022-000370 VO 5 IS 1 A1 Ken Nagata A1 Hiroshi Inoue A1 Takeshi Yamashita A1 Masaharu Akao A1 Hirotsugu Atarashi A1 Takanori Ikeda A1 Yukihiro Koretsune A1 Ken Okumura A1 Wataru Shimizu A1 Shinya Suzuki A1 Hiroyuki Tsutsui A1 Kazunori Toyoda A1 Atsushi Hirayama A1 Takenori Yamaguchi A1 Satoshi Teramukai A1 Tetsuya Kimura A1 Yoshiyuki Morishima A1 Atsushi Takita A1 Masahiro Yasaka YR 2023 UL http://neurologyopen.bmj.com/content/5/1/e000370.abstract AB Background This subcohort study of All Nippon AF In the Elderly (ANAFIE) Registry based on 33 275 elderly patients (aged ≥75 years) with non-valvular atrial fibrillation (NVAF) investigated the relationship between cognitive function and 2-year clinical outcomes.Methods A total of 2963 (mean age, 81.4 years) patients participated in this subcohort study and were classified as having normal cognition (Mini-Mental State Examination (MMSE) score ≥24/30) or cognitive impairment (score ≤23/30) at baseline. Patients with a decrease of >2 points after 24 months were classified as having cognitive decline.Results At baseline, 586 (19.8%) patients had cognitive impairment. These patients tended to be older and had poorer general conditions than patients with normal cognition. The 2-year probability of stroke/systemic embolic events (SEEs), major bleeding and intracranial haemorrhage was numerically higher; those of cardiovascular death, all-cause death and net clinical outcome (composite of stroke/SEE, major bleeding and all-cause death) were significantly higher (all p<0.001) in patients with cognitive impairment versus normal cognition. In multivariate analysis, the risks of cardiovascular death (p=0.021), all-cause death (p<0.001) and net clinical outcome (p<0.001) were higher in patients with cognitive impairment versus those with normal cognition. After 24 months, 642 of 1915 (33.5%) patients with repeated MMSE determination had cognitive decline. Educational background <9 years, older age and concomitant cerebrovascular disorders were significant risk factors of cognitive decline at the 2-year follow-up.Conclusions Elderly patients with NVAF with cognitive impairment have a higher mortality risk than those with normal cognition. Several significant risk factors of cognitive decline were identified at 2-year follow-up.Trial registration number UMIN000024006 (http://www.umin.ac.jp/).Data are available upon reasonable request.